University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.

dc.description.abstract

This research situated antenatal education within a health promotion framework to
determine a consumer-based approach to improving antenatal and postnatal education
purported to prepare for parenthood. Research, both published and unpublished,
criticises current structured educational programs and first time parents are reported to
experience high levels of stress and unhappiness.
Stage One of this study was a multiple source, multiple methods needs assessment
conducted at two large, metropolitan hospitals in Sydney. The aim of the needs
assessment was to explore the needs, interests and concerns of first time expectant and
new parents, their changing nature during the childbearing year, ascertain learning
processes that best suited their needs, and plan effective antenatal education around the
results. Repeated in-depth interviews, focus groups, participant observation and surveys
were used to collect data from expectant and new parents. Focus groups, surveys and
participant observation were used to collect complementary data from educators,
midwives and Child and Family Health Nurses who work with expectant and new
parents. The third source of data analysed was documentary, that is program outlines
and session plans of three comparable hospitals.
The needs assessment demonstrated that to effectively prepare women and men for their
childbearing experience, a range of strategies, programs and learning activities were
required. This resulted in the design of a ‘menu’1 approach to antenatal and postnatal
education with an emphasis placed on ‘life as a mum and a dad’, and the ‘world’ of
their baby. The results also demonstrated a significant difference existed between the
actual learning needs and priorities of expectant and new parents and those perceived to
be their needs by the professionals. Expectant and new parents questioned the group
facilitation skills of educators and identified methods to improve practice.
Three strategies identified by these expectant and new parents as priorities were
designed, implemented and an evaluation of each was undertaken in Stage Two of this
study. The strategies were:
1. Seven session Having a Baby program for first time parents.
2. Group skills training program for antenatal and postnatal educators.
3. Breastfeeding resource package for antenatal educators.
Stage Three of this research was an empirical study. A repeated measures randomised
control trial was undertaken to test the effectiveness of the new Having a Baby program.
In particular whether women and men who attended this program had improved
perceived parenting self-efficacy, knowledge, and decreased worry about the baby eight
weeks after birth compared with those who attended the conventional antenatal
education program. The new program placed the labour and birth experience as a
microcosm of the childbearing experience, and incorporated learning activities designed
to enhance the confidence of pregnant women and their partners during their adjustment
to parenthood. Perceived parenting self-efficacy2 was the measure by which parenting
confidence, and therefore adjustment to parenthood, was measured
The randomised control trial demonstrated that the perceived parenting self-efficacy of
women and men in the experimental group was higher than those of control group
participants at approximately eight weeks after the birth, with the difference being
statically significant. The labour and birth outcomes of both groups, and their
demographic details, were similar.
Evaluation of the group skills training program for antenatal and postnatal educators
and the breastfeeding resource package for antenatal educators were undertaken. Data
collected from focus groups, interviews and surveys demonstrated the effectiveness of
these strategies.
The findings of this research question the validity of conventional antenatal classes and
confirm the need for training and mentoring of antenatal educators. Effective, high
quality antenatal education operating within budget allocation, facilitated by group
skills trained educators, can produce superior postnatal outcomes.